2. Patient Personal Info
Name: T.K
AGE: 32
GENDER: MALE
OCCUPATION: SALESMAN IN SMALL STAND
NATIONALITY: LEBANESE
MARITAL STATUS: SINGLE
MENTAL STATUS: not stable
4. MEDICAL HISTORY & Medication
Epileptic patient( seizures started
when he was 7 affected his mental
growth)
Takes anti-epileptic medications for
more than 20 years:
a) NEUROTOP RETARD 300mg
b) Gardenal 100mg
7. Oral tissue examination
Palate: yellowish pigmentation
Cheek: cheek bitten
Lips: normal
Floor of mouth: normal
Tongue: - fissured &glossitis
(because of Biting during seizures)
-yelowish pigmentation due
to chromogenic bacteria stuck in
fissures)
12. PERIODENTAL
EXAMINATION
GINGIVA:
I. Moderate generalized gingivitis
II. Mild inflamation(not sever because he
stopped taking his medication from 2
months)
Oral hygiene:
I. Poor oral hygiene
II. Extrinsic stains
No fremitus
No tenderness on percussion
17. Epileptic Patient
What is epilepsy and what are
Its types?
Epilepsy is a brain disorder characterized by
excessive neuronal discharge that can produce
seizures, unusual body movements, and loss o
changes in consciousness.
Prevalence
1. < 1%
2. 75% no known etiology
3. Higher frequency in males
18.
19. ORAL MANIFESTAIONS OF
EPILEPTIC PATIENTS
Increased risk for:
1. dental caries
2. oral trauma
3. laceration, including bite injuries to
tongue
4. Broken anterior teeth(because his
parents put a spoon in his mouth during
seizures to prevent tongue swallowing
thus he bites heavily on metal)
20. 5-trauma-induced TMJ disc dislocation
requiring reduction
6- trauma-induced tooth avulsion
7-attrition of teeth due to grinding of teeth
during seizures
21. 1. ulcerations and glossitis as a result of
medication-induced B-12 deficiency
2. Medication-induced gingival hyperplasia,
bleeding gums, xerostomia& delayed
healing
3. Drug interaction with metronidazole&
erythromycin
ANTI-EPILEPTIC DRUGS ORAL SIDE-
EFFECTS
22. Precautions taken in dental office
Maximum precautions should be taken to prevent
occurance of seizures:
1. Collecting info about seizure and their occurrence
2. Taking short appointments in time of day where
seizure occur the least
3. Minimize stress and anxiety and prevent doing
actions that disturb the patient
23. 4-Explaining procedure for patient before
starting
5-Light triggers epileptic shock so prevent
light from entering the patients eyes or use
dark eye protection
24. What to do if seizure occurs in
office?
Remove all foreign objects from mouth
Remove all intsruments next to him or her
Place chair in supine position
Turn the patient on his side if possible to
prevent tongue swallowing
Do not put fingers in mouth because they
might be bitten
25. When the seizure takes too long!!
If the seizure takes more than 5 minutes:
1. Call 911
2. Administer oxygen at rate of 6-8L/minute
3. Administer:
a. 10mg diazepam IM or IV
b. 2mg ativan IV or IM
26. ONCE THE SEIZURE IS OVER
1. STOP any dental treatment in the day
2. Talk to patient & evaluate conscious phase
3. Do not restarin the patient and try not to
embaress him or her
4. Do not allow the patient to leave office
before completely restoring conscious
(better if relative called to take him home)
5. Do brief oral examination for any seizure
related injuries